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Ther Adv Med Oncol. 2019 Feb 25;11:1758835919827714. doi: 10.1177/1758835919827714. eCollection 2019.

Post-neoadjuvant treatment and the management of residual disease in breast cancer: state of the art and perspectives.

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Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium.
Breast International Group, Brussels, Belgium.
Institut Jules Bordet, Université Libre de Bruxelles, Boulevard de Waterloo 121, 1000 Bruxelles, Belgium.


Achieving a pathologic complete response after neoadjuvant treatment is associated with improved prognosis in breast cancer. The CREATE-X trial demonstrated a significant survival improvement with capecitabine in patients with residual invasive disease after neoadjuvant chemotherapy, and the KATHERINE trial showed a significant benefit of trastuzumab-emtansine (TDM1) in human epidermal growth factor receptor 2 (HER2)-positive patients who did not achieve a pathologic complete response after neoadjuvant treatment, creating interesting alternatives of post-neoadjuvant treatments for high-risk patients. New agents are arising as therapeutic options for metastatic breast cancer such as the cyclin-dependent kinase inhibitors and the immune-checkpoint inhibitors, but none has been incorporated into the post-neoadjuvant setting so far. Evolving techniques such as next-generation sequencing and gene expression profiles have improved our knowledge regarding the biology of residual disease, and also on the mechanisms involved in treatment resistance. The present manuscript reviews the current available strategies, the ongoing trials, the potential biomarker-guided approaches and the perspectives for the post-neoadjuvant treatment and the management of residual disease after neoadjuvant treatment in breast cancer.


breast cancer; chemotherapy; pathologic complete response; post-neoadjuvant; residual disease

Conflict of interest statement

Conflict of interest statement: The authors declare the following potential conflicts of interest: Prof Martine Piccart: Board member of Radius. Consultant (honoraria): AstraZeneca, Lilly, MSD, Novartis, Odonate, Pfizer, Roche-Genentech, Camel-IDS, Crescendo Biologics, Periphagen, Huya, Debiopharm, PharmaMar, G1 Therapeutics, Menarini, Seattle Genetics, Immunomedics, Oncolytics. Research grants to the institute: AstraZeneca, Lilly, MSD, Novartis, Pfizer, Roche-Genentech, Synthon, Radius, Servier. Speakers bureau/stock ownership: none. Rafael Caparica: Speaker Boehringer-Ingelheim and Astra Zeneca outside the submitted work. Noam Pondé and Debora Fumagalli: None to declare. Matteo Lambertini: Consultant for Teva and received honoraria from Theramex outside the submitted work. Evandro de Azambuja: Roche-Genentech, research grant from Roche-Genentech (to the institution) and travel grants from Roche-Genentech and GlaxoSmithKline outside the submitted work.

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